A Comparative Study of Chest X-Ray in Febrile Neutropenic Patients with and without Pulmonary Sign

Document Type : Original Article (s)

Authors

1 Assistant Professor, Infectious Disease and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Students Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Infection, especially pulmonary infection and pneumonia, is a major cause of morbidity and mortality in patients with cancer treated with chemotherapy. Chest X-ray (CXR) is an initial guide, quick, inexpensive, available and low-radiation dose widely performed when pneumonia is suspected. According to various studies, the role of routine CXR in the diagnostic evaluation of febrile neutropenic patients without pulmonary symptoms is unclear. The purpose of this study was to evaluate the diagnostic yield of routine CXR in asymptomatic pulmonary neutropenic patients.Methods: 118 neutropenic patients (59 men and 59 women) with the age of more than 18 years were studied. History, physical examination, complete blood count (CBC), blood culture, urine analysis (U/A), and urine culture (U/C) were checked. In both, symptomatic and asymptomatic patients, 2 CXRs [Posterior-Anterior (PA) and lateral] were obtained and one radiologist studied CXRs without knowing about the physical examination.Findings: The incidence of pneumonia in was 17.8% in the entire population and 6.8% in asymptomatic pulmonary group. The incidence of pneumonia was significantly higher in men than in women (P = 0.04); the incidence of pneumonia significantly increased with age increasing (P = 0.01).Conclusion: Comparing our findings to similar studies, routine CXR in febrile neutropenic men with the age of more than 50 years is recommended.

Keywords

References

  1. Chanock S. Evolving risk factors for infectious complications of cancer therapy. Hematol Oncol Clin North Am 1993; 7(4): 771-93.
  2. Höffken K Antibiotische therapie bei neutropenischem fieber. Onkologe 1995 ;1: 503-510.
  3. Hiddemann W, Maschmeyer G, Runde V, Einsele H. (Prevention, diagnosis and therapy of infections in patients with malignant diseases. Internist (Berl) 1996; 37(12): 1212-24. [In German].
  4. Maschmeyer G, Link H, Hiddemann W, Meyer P, Helmerking M, Eisenmann E, et al. Empirical antimicrobial therapy in neutropenic patients. Results of a multicenter study by the Infections in Hematology Study Group of the Paul Ehrlich Society. Med Klin (Munich) 1994; 89(3): 114-23. [In German].
  5. Pizzo PA, Robichaud KJ, Gill FA, Witebsky FG. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 1982; 72(1): 101-11.
  6. Einsele H, Bertz H, Beyer J, Kiehl MG, Runde V, Kolb HJ, et al. Epidemiology and interventional treatment strategies of infectious complications after allogenic stem-cell transplantation. Dtsch Med Wochenschr 2001; 126(45): 1278-84. [In German].
  7. Talcott JA, Siegel RD, Finberg R, Goldman L. Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule. J Clin Oncol 1992; 10(2): 316-22.
  8. Jochelson MS, Altschuler J, Stomper PC. The yield of chest radiography in febrile and neutropenic patients. Ann Intern Med 1986; 105(5): 708-9.
  9. Maschmeyer G. Pneumonia in febrile neutropenic patients: radiologic diagnosis. Curr Opin Oncol 2001; 13(4): 229-35.
  10. Sickles EA, Greene WH, Wiernik PH. Clinical presentation of infection in granulocytopenic patients. Arch Intern Med 1975; 135(5): 715-9.
  11. Azoulay E, Darmon M, Delclaux C, Fieux F, Bornstain C, Moreau D, et al. Deterioration of previous acute lung injury during neutropenia recovery. Crit Care Med 2002; 30(4): 781-6.
  12. Donowitz GR, Harman C, Pope T, Stewart FM. The role of the chest roentgenogram in febrile neutropenic patients. Arch Intern Med 1991; 151(4): 701-4.
  13. Rolston KV. New trends in patient management: risk-based therapy for febrile patients with neutropenia. Clin Infect Dis 1999; 29(3): 515-21.
  14. Oude Nijhuis CS, Gietema JA, Vellenga E, Daenen SM, De Bont ES, Kamps WA, et al. Routine radiography does not have a role in the diagnostic evaluation of ambulatory adult febrile neutropenic cancer patients. Eur J Cancer 2003; 39(17): 2495-8.
  15. Katz JA, Bash R, Rollins N, Cash J, Buchanan GR. The yield of routine chest radiography in children with cancer hospitalized for fever and neutropenia. Cancer 1991; 68(5): 940-3.
  16. Renoult E, Buteau C, Turgeon N, Moghrabi A, Duval M, Tapiero B. Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer? Pediatr Blood Cancer 2004; 43(3): 224-8.
  17. Feusner J, Cohen R, O'Leary M, Beach B. Use of routine chest radiography in the evaluation of fever in neutropenic pediatric oncology patients. J Clin Oncol 1988; 6(11): 1699-702.
  18. Korones DN, Hussong MR, Gullace MA. Routine chest radiography of children with cancer hospitalized for fever and neutropenia: is it really necessary? Cancer 1997; 80(6): 1160-4.
  19. Hann I, Viscoli C, Paesmans M, Gaya H, Glauser M. A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC). Br J Haematol 1997; 99(3): 580-8.
  20. Heussel CP, Kauczor HU, Heussel G, Derigs HG, Thelen M. Looking for the cause in neutropenic fever. Imaging diagnostics. Radiologe 2000; 40(1): 88-101. [In German].
  21. Rossini F, Verga M, Pioltelli P, Giltri G, Sancassani V, Pogliani EM, et al. Incidence and outcome of pneumonia in patients with acute leukemia receiving first induction therapy with anthracycline-containing regimens. Haematologica 2000; 85(12): 1255-60.
Journal of Isfahan Medical School
Volume 31, Issue 246 - Serial Number 246
May and June 2013
Pages 1124-1133

Files

History

  • Receive Date: 09 March 2013
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics